This study compared the relative efficacy of two different cardiac rehabilitation programmes on psychosocial outcome following a first Myocardial Infarction (MI). A 6 months longitudinal design was used to assess changes over time in the following psychosocial variables: locus of control, significant other support, illness perceptions, anxiety, depression, generalized self-efficacy and coping. The study also examined the value of these same variables in predicting health service utilization, specifically GP contact and hospital admissions, over the 6 month period after the MI. The results of the present study suggest that the provision of the Edinburgh Heart Manual confers some advantages on cardiac patients. Specifically, patients receiving the manual report stronger beliefs in their ability to control the illness and less depression over the follow-up period compared with patients receiving a hospital-based exercise and education programme. Patients receiving the manual (hospital 1) reported more emotional support than patients from hospital 2, when baseline and follow-up data were combined. Patients in hospital 1 demonstrated significant reductions in levels of clinical anxiety and depression. Baseline anxiety helped to predict GP consultations in the subsequent 6 months. Psychosocial variables did not significantly contribute to the prediction of hospital admissions in the follow-up period. The results are discussed in terms of fixture service developments and the implications for the provision of an effective cardiac rehabilitation service. Methodological problems, specifically the small number of readmissions (n=21) and the psychometric properties of some of the measures used (variable internal reliability and low test-retest correlations) are highlighted as possible explanations for the failure to get a significant result with psychosocial variables and hospital admissions.